J. U. Prause

LACRIMAL AND SALIVARY SECRETION IN SJÖGREN'S SYNDROME: THE EFFECT OF SYSTEMIC TREATMENT WITH BROMHEXINE

In a randomized clinical study, 32 patients with Sjögrens syndrome (SS) were given placebo/bromhexine (Bisolvon®) 48 mg daily for 3 weeks. Various ophthalmological and oral variables as well as different proteins in tear fluid and saliva were registered. Bromhexine stimulated the tear secretion significantly, presumably without changing the protein composition of the tear fluid. In saliva the IgM concentration in contrast to other proteins decreased in patients with high pre‐treatment values. Bromhexine may be of valuable help in the treatment of some patients with SS.

Structure and composition of the inner limiting membrane of the retina. SEM on frozen resin-cracked and enzyme-digested retinas of Macaca mulatta.

After a historical introduction describing previous observations and views on the structure and composition of the internal limiting membrane of the retina (MLI), it is concluded that no definite unifying concept exists concerning the MLI structure. The authors applied frozen resin cracking with hexamethyldisilazane (HMDS) desiccation on normal and enzyme-digested specimens of monkey retinas. Distinct differences were observed between equatorial, macular, and optic disc regions. The MLI in the equatorial and disc regions was about 70 nm thick with an outer dense, basement membranelike part and an inner, loose fibrillar meshwork fusing with the vitreous fibers. The foveal region was 400 nm thick; the dense outer layer was thicker than normal basement membrane, whereas the inner loose meshwork had only a few fibrils. The enzyme-digestion experiments showed that the fibrillar meshwork consisted mainly of collagen fibers surrounded by predominantly hyaluronic acid.

Serum albumin, serum antiproteases and polymorphonuclear leucocyte neutral collagenolytic protease in the tear fluid of patients with corneal ulcers.

Using a micro‐electroimmune assay, the concentration of polymorphonuclear leucocyte neutral collagenolytic protease, serum‐albumin, α‐1‐antitrypsin and α‐2‐macroglobulin were measured in the tear fluid from 18 eyes of 16 patients with severe, melting corneal ulcers. By this method, PML‐c‐ase was the first time detected in tear fluid. All proteins normalized during healing of the ulcer. The findings are indicative of an important role for PML‐proteases in the degradation of the corneal stroma, and of a regulative effect of the serum antiproteases leaking into the tear fluid from inflamed conjunctival vessels.

MORPHOLOGICAL, HISTOCHEMICAL AND X‐RAY MICROANALYTICAL EXAMINATION OF DEPOSITS ON SOFT CONTACT LENSES IN EXTENDED WEARING

The deposits on 29 contact lenses of various water content from 20 wearers were analysed by the methods given in the title. Six lenses were used as bandage lenses, the remaining for optical correction. The age of the patients varied from 7 to 56 years, two‐thirds being under 45 years.

Structure and composition of Bowman's membrane. Study by frozen resin cracking.

Bowmans membrane, seen as a homogeneous layer in light microscopy, is demonstrated by transmission electron microscopy as a layer with fibrils in random distribution, for which reason the term used at present is Bowmans layer. Frozen resin cracking demonstrates that the fibrils of the layer run in certain patterns and lie in 3 or 4 strata in the central areas of the cornea. In the periphery, stratification is scarcely demonstrable. The fibrils consist of collagen inseparable by histochemical methods from the collagen in the stroma, but the diameter is only half or two‐thirds of the diameter of the stromal fibrils. The authors discuss the possibility that artifacts are responsible for the findings. However, an explanation of the results may be that Bowmans layer is a condensation of the superficial layers of the stroma resulting from the development of the layer. The fibrils are presumed to break in different ways, but apparently in layers in which the breaking strengths are identical.

Structure of the vitread face of the monkey optic disc (Macacca mulatta)

The authors applied frozen resin cracking after hexamethyldisilazane (HMDS) desiccation on the monkey optic disc region. The cracked face through the central part of the optic disc showed that the inner limiting membrane of the retina continued into the limiting membrane of Elschnig, and this, in turn, continued into the central meniscus of Kuhnt. At the disc margin the membrane was about 70 nm in thickness, due to a large fibrillar component. Elschnigs membrane was about 50 nm in thickness and was composed of both fibrils and flocculent material. The membrane covering the central meniscus of Kuhnt was about 20 nm in thickness. The number of fibrils here was very low, and the membrane consisted of flocculent material. The positive immunohistochemical stainings for GFA and vimentin of Elschnigs membrane and Kuhnts meniscus were noteworthy. The positive staining disappeared when the membrane continued into the inner limiting membrane of the retina, supporting the different structural composition.

SERUM ALBUMIN, SERUM ANTIPROTEASES AND POLYMORPHONUCLEAR LEUCOCYTE NEUTRAL COLLAGENOLYTIC PROTEASE IN THE TEAR FLUID OF NORMAL HEALTHY PERSONS

Using a micro‐electroimmune assay and a ‘non‐reflex stimulating’ method to collect normal tear fluid, the concentration of the serum proteins albumin (S‐A), alfa‐1‐antitrypsin (α1A), alfa‐1‐antrichymotrypsin (α1X) and alfa‐2‐macroglobulin (α1M) was determined in the tear fluid of 53 normal persons. In addition, the tear fluid was tested for the content of polymorphonuclear leucocyte neutral collagenolytic protease (PML‐c‐ase). PML‐c‐ase and α1X could not be detected in any tear samples. The concentrations of S‐A, α1A and α1M were constant over time, and showed no variation with sex, age or between the right and left eyes. There was no correlation between the concentration levels of the detected proteins in the tear fluid and correlation between tear fluid levels and corresponding serum concentration levels of the proteins could not be shown.

Immunoelectrophoretic determination of tear fluid proteins collected by the Schirmer I test.

Using reservoirs containing 50 μl of antigen solution in combination with a micro‐modification of the electroimmunoassay a detection limit of 0.05 ng applied in 400 μl corresponding to 0.125 ng/ml has been achieved.

SERUM ANTIPROTEASES AND POLYMORPHONUCLEAR LEUCOCYTE NEUTRAL COLLAGENOLYTIC PROTEASE IN THE TEAR FLUID OF PATIENTS WITH CORNEAL ULCERS TREATED WITH N-BUTYLCYANO ACRYLATE GLUE

Four patients with central melting perforating corneal ulcers were treated by n‐butylcyano acrylate gluing of the ulcer region. The glue facilitated healing of the eyes, and when the glue scaled off weeks later the corneas were left with stable leucomas. The glue membrane appears to prevent tear‐borne polymorphonuclear leucocytes (PML) from reaching the ulcer region and to diminish activation of PML, with the consequent dramatic fall in tear fluid polymorphonuclear leucocyte neutral collagenolytic protease (PML‐c‐ase). After gluing, the tear fluid content of serum antiproteases returns to normal levels within days. This might indicate a decreased leakage of proteins from conjunctival vessels.

PAS-positive polymorphonuclear leucocytes in corneal ulcers.

Fifty consecutive cases of severe keratitis with clinical signs of corneal ulcers were examined histologically for the stage of inflammatory reaction. Further, 14 similar cases were studied ultrastructurally.